Deductibles for HealthSelect plans restarted Jan. 1

January 12, 2022
Your prescription drug deductibles and any medical deductibles in the HealthSelectSM plans restarted on Jan. 1. You have to reach the deductible amount before the plan pays its share. Coinsurance and total out-of-pocket maximums also started over

How much is my prescription drug plan deductible?

Except for Consumer Directed HealthSelectSM (which has one deductible covering medical services and prescription drugs), all HealthSelect prescription drug plans have a $50 annual deductible.

How much is my medical plan deductible?

See the HealthSelect plan deductibles in the table below. The Health Plans Comparison Chart on the ERS website shows the deductible and coinsurance amounts for the non-Medicare HealthSelect plans. (See the Health Plan Comparison Chart for participants enrolled in Medicare.) 

Keep in mind that eligible in-network preventive care is always covered at 100%, no matter which plan you’re in. 

If participant is enrolled in: How much is the medical deductible?
HealthSelect of Texas® (your eligibility county on file with ERS is in Texas and you’re not eligible for Medicare) In-network: $0

Out-of-network: $500 per individual; $1,500 per family
HealthSelectSM Out-of-State (your eligibility county on file with ERS is outside Texas and you’re not eligible for Medicare In-network: $0

Out-of-network: $500 per individual; $1,500 per family
Consumer Directed HealthSelectSM high-deductible plan

NOTE: If you are enrolled in family coverage, the entire family deductible amount must be met before non-preventive benefits are paid for any individual family member.

 
In-network: $2,100 per individual; $4,200 per family

Out-of-network: $4,200 per individual; $8,400 per family

NOTE: Consumer Directed HealthSelect has a combined medical and pharmacy deductible, which means that the plan won’t pay anything for medical (except in-network preventive care) and prescription drug expenses until you meet the deductible.

How much is the annual out-of-pocket maximum?

The total annual in-network out-of-pocket maximums for the non-Medicare plans are $7,000 per individual and $14,000 per family. If two eligible individuals in a family meet the $7,000 maximum for a total of $14,000, then the family’s out-of-pocket maximum is met. The out-of-pocket maximum includes eligible expenses for both medical and pharmacy.